Functional quad
Can someone please clarify the criteria for functional quad (as it relates to the underlying condition). Pontine stroke (would be locked in syndrome). Spinal injury would be an actual quad.
The coding clinic in 2016 added "the brain": "....by another medical condition without physical injury or damage to the brain or spinal cord....".
This addition is confusing, as Alzheimer's is a brain condition and it is allowed (and actually one of the diagnoses the coding clinic references as allowing for functional quad).
I am asking for an example like for a patient who suffered something like a hemorrhagic stroke and is in a persistent vegetative state (just one example)...who has no real impairment to the spinal cord that prohibits the movement (like a spinal cord injury).
There is not an excludes 1 note for the above type situation... but the functional quad is a code listed in spinal cord injuries codes, as an excludes one (and also for the locked in syndrome code) - among other diagnoses, with the functional quad listed as an excludes 1.
Because of that.. I am looking for some clear cut help.
Seems like the more I research the more divided people are.
This attached article from 2019 only references spinal injury:
Identifying and Documenting Functional Quadriplegia | Sound Physicians
And this article on HCPro from 2016 also conflicts with the 2016 coding rule:
Clinically Speaking: Check CDI efforts related to functional quadriplegia - www.hcpro.com
Comments
I should clarify somewhat... while the coding clinic was officially removed.. there still are two different definitions floating around:
The 1st link (above) defines functional quad as "Functional quadriplegia is the complete inability to move due to severe disability or frailty caused by another medical condition without physical injury or damage to the spinal cord
The 2nd link states the same and gives the below examples as common causes:
"The most common cause of functional quadriplegia is advanced brain and/or neuromuscular degeneration from such things as dementia, hypoxic or traumatic brain injury, multiple sclerosis, amyotrophic lateral sclerosis (ALS), Huntington’s disease, profound intellectual/ mental disability, and similar conditions........"
Then other places/sites/resources state "Functional quadriplegia (or quadriparesis) is defined as the complete inability to move due to severe disability or frailty caused by another medical condition without physical injury or damage to the brain or spinal cord."
Even the 2021 ACDIS Pocket Guide states "without physical injury or damage to the brain of the spinal cord" (page 441).
Where did "the brain" come from?
Also to note, the ACDIS Pocket Guide's CDI critical thinking essentially copied Dr. Pinson's most common causes from the 2nd link, but removed "hypoxic or traumatic brain injury" from the examples.
These changes are what has led to the confusion.